Care Manager I (RN)
Job Description
Job Title: Care Manager (RN)Job Location: Fully remote- can sit anywhere in the US but must have a CA RN license and be able to work PST hours listed.
Job Duration: 3 Months (Possible to extend)
Walk me through the day to day responsibilities of this the role and a description of the project (Outside of Workday JD):
- Experience Working with Medicare/Medicaid
- Assisting with Backlog-referrals from CA-members sending referrals to case managers
- Will be Assigned 5-10 referrals daily.
- Ability to work in Fast paced environment.
- Case Management exp required.
- At least 4 hours a day is spent on outbound phone calls-reaching out to members.
- Calls are recorded-will have audio audits.
- Data entry-tracking data
- Case load requirement is 75-(will be ramped up to this amt)
- Excel (data entry-basic knowledge)
- True Care medical records system
- Must be able to navigate multiple systems.
- Pharmacy system, eligibility system, Workforce management
* Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options
* Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clients
* Develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs
* Provide patient and provider education
* Facilitate member access to community based services
* Monitor referrals made to community based organizations, medical care and other services to support the members' overall care management plan
* Actively participate in integrated team care management rounds
* Identify related risk management quality concerns and report these scenarios to the appropriate resources
* Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems* Monitor referrals made to community based organizations, medical care and other services to support the members' overall care management plan
* Actively participate in integrated team care management rounds
* Identify related risk management quality concerns and report these scenarios to the appropriate resources
* Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systemsals, treatment and provider options
* Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clients
* Develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs
* Provide patient and provider education
* Facilitate member access to community based services
* Monitor referrals made to community based organizations, medical care and other services to support the members' overall care management plan
* Actively participate in integrated team care management rounds
* Identify related risk management quality concerns and report these scenarios to the appropriate resources
* Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems
Education/Experience: Graduate from an Accredited School of Nursing. Bachelor's degree in Nursing preferred. 2+ years of clinical nursing experience in an clinical, acute care, or community setting. Knowledge of healthcare and managed care preferred.
Licenses/Certifications: Current state's RN license.
| Required Skills/Experience: | Preferred Skills/ Experience: | ||||||
| 1. | Experience with Medicare/Medicare required | 1. | Psych/Behavioral Health Background/Experience | ||||
| 2. | Case management experience | 2. | Bilingual in Spanish | ||||
| 3. | 3. | ||||||
| Education Requirement: | Current RN license in CA | Education Preferred: | |||||
| Software Skills Required: | MS Office, Excel | ||||||
| Required Certifications: | Required Testing: | ||||||
SPECTRAFORCE is an equal opportunity employer and does not discriminate against any employee or applicant for employment because of race, religion, color, sex, national origin, age, sexual orientation, gender identity, genetic information, disability or veteran status, or any other category protected by applicable federal, state, or local laws. Please contact Human Resources at nahr@spectraforce.com if you require reasonable accommodation.
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